The risk of development of acute kidney injury in full-term infants with administration of methylxanthines
DOI:
https://doi.org/10.14739/2310-1237.2021.2.230342Keywords:
acute kidney injury, creatinine, methylxanthines, newbornAbstract
Exploring new possibilities for the use of methylxanthines to prevent the development of acute kidney injury (AKI) in full-term infants with perinatal asphyxia.
Aim: to evaluate the efficacy and safety of methylxanthines in full-term infants for the prevention and conservative treatment of acute kidney injury.
Materials and methods. To test the effectiveness of the proposed method of AKI treatment, 38 infants were chosen and divided into 2 groups by random selection. Nursing and intensive care were according to current legislation (Order of the Ministry of Health of Ukraine No. 225 of March 28, 2014). The main group (n = 20) received therapy with caffeine citrate, the comparison group (n = 18) – theophylline. Both of these drugs were used to prevent the development of acute kidney injury – stage II and III according to KDIGO.
Results. A significant difference in serum creatinine was found in the main group - the level of serum creatinine was higher than in the comparison group, but did not exceed the physiological norm. GFR on the 3rd day of life was higher with administration of theophylline, but in the group of caffeine did not exceed the reference values of the norm. No differences between urea levels and diuresis rates were found in the groups. The initial results indicate the lack of statistical significance when using various drugs of the methylxanthine group, namely theophylline and caffeine citrate. This is explained by the fact that in the main group 65.00 % (n = 13) of patients had AKI stage 0 according to KDIGO, and 35.00 % (n = 7) had stage I. In the comparison group, 55.56 % (n = 10) and 44.44 % (n = 8), respectively. Stages II and III in both groups of the study did not develop, the obtained data are equivalent – U = 163,00; P = 0,6296. However, the use of caffeine citrate may become a priority due to a better safety profile compared to theophylline. Caffeine is less likely to cause adverse effects in the form of non-pathological bile vomiting and has significantly lower relative risk of non-pathological bile vomiting in infants (RR 0.26 (95 % CI 0.10; 0.66)).
Conclusions. Conservative methylxanthine therapy in full-term infants with perinatal asphyxia prevents the development of stages II and III of AKI according to KDIGO. However, it is necessary to continue the collection of material to increase the statistical significance, as well as to study the early and long-term consequences of this therapy.
References
Kellum, J. A., Aspelin, P., Barsoum, R. S., Burdmann, E. A., Goldstein, S. L., … & Uchino, Shigehiko. (2012). KDIGO Clinical Practice Guideline for Acute Kidney Injury / Kidney International Supplements. 2012. Vol. 2, Iss. 1. P. 1-138.
Gupta, C., Massaro, A. N., & Ray, P. E. (2016). A new approach to define acute kidney injury in term newborns with hypoxic ischemic encephalopathy. Pediatric nephrology, 31(7), 1167-1178. https://doi.org/10.1007/s00467-016-3317-5
Kaur, S., Jain, S., Saha, A., Chawla, D., Parmar, V. R., Basu, S., & Kaur, J. (2011). Evaluation of glomerular and tubular renal function in neonates with birth asphyxia. Annals of tropical paediatrics, 31(2), 129-134. https://doi.org/10.1179/146532811X12925735813922
Libório, A. B., Branco, K. M., & Torres de Melo Bezerra, C. (2014). Acute kidney injury in neonates: from urine output to new biomarkers. BioMed research international, 2014, 601568. https://doi.org/10.1155/2014/601568
Oliveros, M., Pham, J. T., John, E., Resheidat, A., & Bhat, R. (2011). The use of bumetanide for oliguric acute renal failure in preterm infants. Pediatric critical care medicine, 12(2), 210-214. https://doi.org/10.1097/PCC.0b013e3181e912a7
Tamburro, R. F., Thomas, N. J., Ceneviva, G. D., Dettorre, M. D., Brummel, G. L., & Lucking, S. E. (2014). A prospective assessment of the effect of aminophylline therapy on urine output and inflammation in critically ill children. Frontiers in pediatrics, 2, 59. https://doi.org/10.3389/fped.2014.00059
Selewski, D. T., Charlton, J. R., Jetton, J. G., Guillet, R., Mhanna, M. J., Askenazi, D. J., & Kent, A. L. (2015). Neonatal Acute Kidney Injury. Pediatrics, 136(2), e463-e473. https://doi.org/10.1542/peds.2014-3819
Hodovanets, Yu. D., & Babintseva А. G. (2018). Intensyvna terapiia novonarodzhenykh: udoskonalennia pidkhodiv korektsii renalnykh porushen za umovy perynatalnoi patolohii [Intensive care of newborns: improvement of approaches to the correction of renal disorders under perinatal pathology]. Zdorovia dytyny, 13(3), 302-310. https://doi.org/10.22141/2224-0551.13.3.2018.132913
Bhatt, G. C., Gogia, P., Bitzan, M., & Das, R. R. (2019). Theophylline and aminophylline for prevention of acute kidney injury in neonates and children: a systematic review. Archives of disease in childhood, 104(7), 670-679. https://doi.org/10.1136/archdischild-2018-315805
Bellos, I., Pandita, A., & Yachha, M. (2019). Effectiveness of theophylline administration in neonates with perinatal asphyxia: a meta-analysis. The journal of maternal-fetal & neonatal medicine, 1-9. Advance online publication. https://doi.org/10.1080/14767058.2019.1673722
Harer, M. W., Askenazi, D. J., Boohaker, L. J., Carmody, J. B., Griffin, R. L., Guillet, R., Selewski, D. T., Swanson, J. R., Charlton, J. R., & Neonatal Kidney Collaborative (NKC) (2018). Association Between Early Caffeine Citrate Administration and Risk of Acute Kidney Injury in Preterm Neonates: Results From the AWAKEN Study. JAMA pediatrics, 172(6), e180322. https://doi.org/10.1001/jamapediatrics.2018.0322
Schmidt, B., Roberts, R. S., Davis, P., Doyle, L. W., Barrington, K. J., Ohlsson, A., Solimano, A., Tin, W., & Caffeine for Apnea of Prematurity Trial Group (2006). Caffeine therapy for apnea of prematurity. The New England journal of medicine, 354(20), 2112-2121. https://doi.org/10.1056/NEJMoa054065
Hukui, J., Jones, S., Coughlin, K., Levin, S., & Foster, J. R. (2017). Non-pathological bilious vomiting complicating therapeutic hypothermia for hypoxic ischaemic encephalopathy in neonates: a retrospective cohort study. BMJ paediatrics open, 1(1), e000034. https://doi.org/10.1136/bmjpo-2017-000034
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